CMS pushes digital rulemaking

The federal agency that pays for Medicare just did two very different things on almost the same timeline: it locked in a new digital paperwork standard by March 2026, and days later it finalized a separate 2027 Medicare Advantage rule that rewrites parts of how private Medicare plans are judged and supervised. Those two moves land on the same desks inside health insurers and hospital information-technology teams. (cms.gov, cms.gov) The digital piece is about “claims attachments,” which is the extra proof an insurer asks for after a doctor sends a bill. That proof can include medical records, imaging, lab results, and clinical notes, and the Centers for Medicare & Medicaid Services said the industry still often moves it by fax, mail, or portal-by-portal workarounds. (cms.gov, healthcaredive.com) The new rule adopts the first Health Insurance Portability and Accountability Act standards for sending those attachments electronically. Covered entities must comply by May 2028, which gives payers, hospitals, and software vendors about two years to rebuild old documentation pipelines around a common format. (cms.gov, healthcaredive.com) That sounds narrow until you remember how a Medicare Advantage dispute usually works. A plan denies, pends, or audits a claim, then a provider has to pull records from one system, convert them into whatever the plan wants, and send them through a separate channel that may not talk to the original claim. (healthcaredive.com, cms.gov) The second move is the 2027 Medicare Advantage and Part D final rule that the Centers for Medicare & Medicaid Services issued on April 2, 2026. It takes effect June 1, 2026, and applies to coverage starting January 1, 2027. (cms.gov, federalregister.gov) That rule is not mainly about file formats. It changes the operating rules for private Medicare plans in areas like Star Ratings quality scores, marketing and communications, enrollment processes, special needs plans, and prescription drug coverage administration. (cms.gov, federalregister.gov) One of the bigger shifts is what did not survive from the November 25, 2025 proposal. The proposal had included tougher utilization-management and prior-authorization ideas, but outside analysts say the final rule dropped or softened several of them, including a requirement for annual health-equity analysis of prior-authorization use. (cms.gov, cms.gov, appliedpolicy.com) So the picture now is a split-screen one. The federal government eased back on some proposed Medicare Advantage conduct changes for 2027, while moving ahead on a hard technical deadline that forces the industry to standardize how supporting records travel with payment disputes and reviews. (cms.gov, cms.gov, cms.gov) That is why compliance officers and information-technology teams are suddenly in the same meeting. One rule tells Medicare Advantage plans what they can and cannot do in 2027, and the other tells every affected payer and provider how the underlying evidence has to move by May 2028. (cms.gov, cms.gov) The practical work starts long before 2028. Health plans need attachment workflows that match the new standard, providers need electronic record exports that map cleanly to claims, and vendors need products that can pass documents between both sides without the fax machine becoming the backup plan again. (healthcaredive.com, cms.gov) And this is not the first digital deadline on the calendar. The earlier Centers for Medicare & Medicaid Services interoperability and prior-authorization rule already set January 1, 2027 requirements for application programming interfaces and faster prior-authorization responses for affected payers, so the new attachments rule stacks another build cycle on top of work many organizations already have underway. (cms.gov, cms.gov, cms.gov)